title: Change in fractional anisotropy during treatment of diabetic ketoacidosis in children.
abstract: BACKGROUND
  The pathophysiology resulting in cerebral edema in pediatric diabetic ketoacidosis (DKA) is unknown. To investigate the changes in white matter microstructure in this disease, we measured diffusion tensor imaging (DTI) parameters, including apparent diffusion coefficient (ADC), fractional anisotropy (FA), and radial and axial diffusivity in children with DKA at two time points during treatment.
  
  
  METHODS
  A prospective observational study was conducted at Seattle Children's Hospital, Seattle, WA. Thirty-two children admitted with DKA (pH < 7.3, bicarbonate < 15 mEq/l, glucose > 300 mg/dl, and ketosis; 11.9 ± 3.2 y; and 47% male) were enrolled and underwent two serial paired diffusion magnetic resonance imaging (MRI) scans following hospital admission. Seventeen of the 32 participants had diffusion tensor images of adequate quality for tract-based spatial statistics (TBSS) analysis.
  
  
  RESULTS
  TBSS mapping demonstrated main white matter tract areas with a significant increase in FA and areas with a significant decrease in ADC, from the first to the second MRI. Both radial and axial diffusivity terms showed change, with a diffuse pattern of involvement.
  
  
  CONCLUSIONS
  Consistent DTI changes occurred during DKA treatment over a short time frame. These findings describe widespread water diffusion abnormalities in DKA, supporting an association between clinical illness and DTI markers of microstructural change in white matter.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington.
authors.forename: Leslie
authors.initials: L
authors.lastname: Dervan
authors.affiliation: 1] Department of Radiology, Seattle Children's Hospital, Seattle, Washington [2] Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Andrew
authors.initials: A
authors.lastname: Poliakov
authors.affiliation: 1] Department of Radiology, Seattle Children's Hospital, Seattle, Washington [2] Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Seth D
authors.initials: SD
authors.lastname: Friedman
authors.affiliation: 1] Department of Radiology, Seattle Children's Hospital, Seattle, Washington [2] Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington [3] Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Dennis
authors.initials: D
authors.lastname: Shaw
authors.affiliation: 1] Department of Pediatrics, University of Washington, Seattle, Washington [2] Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington [3] Division of Endocrinology and Diabetes, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pihoker
authors.affiliation: 1] Department of Pediatrics, University of Washington, Seattle, Washington [2] Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Joan S
authors.initials: JS
authors.lastname: Roberts
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Todd
authors.initials: T
authors.lastname: Richards
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Marro
authors.affiliation: 1] Department of Pediatrics, University of Washington, Seattle, Washington [2] Department of Radiology, Seattle Children's Hospital, Seattle, Washington [3] Department of Anesthesiology, University of Washington, Seattle, Washington.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
mesh_terms: D000293:Adolescent; D002648:Child; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies